Pain Killer by Barry Meier

Politics play a critical role in how medical patients are treated. Cultural norms and the politics that implement those norms determine even what is considered a treatable medical condition in the first place.

Nowhere has the politics of medicine been more evident over the last century than in the treatment of pain, as is made starkly clear in award-winning investigative reporter Barry Meier’s compelling expose of the high-powered narcotic OxyContin, “Pain Killer: A Wonder Drug’s Trail of Addiction and Death,” where a legitimate breakthrough in the treatment of chronic severe pain is mingled with multi-billion dollar corporate greed, scientific wishful thinking, regulatory myopia and tragically ruined lives.

The brand name “OxyContin” — a long-acting form of the opium-derived painkiller oxycodone, manufactured by family-owned Connecticut drug company Purdue Pharma — might sound familiar to even the casual observer. It has been splashed across the media over the last few years, including Meier’s Pulitzer Prize-nominated series of articles for the NY Times that serve as the foundation of this book. In addition, conservative commentator Rush Limbaugh recently publicly admitted to being addicted to the drug, rock singer and actress Courtney Love was treated for an “Oxy” overdose, and the teenage son of Ozzy and Sharon Osbourne was treated for dependency.

Meier deftly weaves together the stories of a rural Virginia high-school cheerleader who becomes addicted to crushing and snorting (the method addicts and abusers developed to circumvent the patented time-release action of the pills for a quick, powerful high) OxyContin, which earned the street nickname “hillbilly heroin” for its popularity and availability in Appalachia during an epidemic outbreak in the late- ’90s and early-’00s, her distraught, uncertain mother, a heroic small-town doctor who learns of the drug’s potential for calamity on the frontlines, the DEA official who takes on Purdue, and the immensely wealthy Sackler family that quietly pulls the strings behind Purdue and affiliated companies.

But it is the pendulum swings of the public, media, regulatory and health care community’s attitudes toward pain that made this strange affair possible. For thousands of years opium was used to treat a wide variety of human ailments including pain, but by the mid-nineteenth century it had become clear to many that, quoting Meiers, the “broad use of opiates carried a price.”

By 1900 there were an estimated three hundred thousand morphine (another opium derivative) addicts in the United States, and by the ’20s attitudes toward opiates were such that the Harrison Act banned the prescribing of narcotics to those addicted to them. By the late-’30s over 25,000 doctors had been charged with offenses related to the Act. Doctors were even hesitant to prescribe morphine for advanced cancer patients suffering the severest of pain.

Into this environment the movement to treat pain preemptively with powerful narcotics began twenty years ago, in an effort to alleviate the needless suffering of millions of chronic severe pain sufferers, and attitudes swung heavily in favor of aggressive treatment. Pudue’s greatest sin was to take advantage of this new pro-treatment environment to heavily market OxyContin, which was approved by the FDA in 1995, for use in treatment of moderate and intermittent pain, breaking it out of the relatively limited hard-core pain community into the vastly more lucrative general population. “Pain Killer: A Wonder Drug’s Trail of Addiction and Death” superbly tells the tale of the disastrous results.

A slightly different version of this review appeared in the Cleveland Plain Dealer.